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Provider Awareness Alone Does Not Improve Transition Readiness Skills in Adolescent Patients With Inflammatory Bowel Disease

Fishman, Laurie N.*; Ziniel, Sonja I.; Adrichem, Max E.; Fernandes, Susan M.§; Arnold, Janis*

Journal of Pediatric Gastroenterology and Nutrition: August 2014 - Volume 59 - Issue 2 - p 221–224
doi: 10.1097/MPG.0000000000000405
Original Articles: Gastroenterology

Objective: Adolescent patients with chronic health conditions must gradually assume responsibility for their health. Self-management skills are needed for a successful transfer from adolescent to adult health care, but the development of these skills could be resource intensive. Pediatric providers are already instrumental in teaching patients about their health and may improve these skills. The aim of the study was to evaluate whether informal education of pediatric providers regarding transition improves inflammatory bowel disease (IBD) patient self-management skills.

Methods: Consecutive patients with IBD older than 10 years who presented to the outpatient setting were administered a survey regarding self-management behaviors in 2008 and 2011. During this time, several conferences on transition were presented to the providers.

Results: In 2008, 294 patients completed the survey (82%) compared with 121 patients (89%) in 2011. The patient groups were comparable with respect to sex (boys 50% vs 42%), mean age (16.7 vs 16.2 years), and type of IBD (Crohn 68% vs 66%). The 13- to 15-year-olds reported calling in refills (11%, 8%, respectively), scheduling clinic appointment (0, 1%), preparing questions (13%, 5%), and taking the main role in talking during clinic visits (15%, 24%). The 16- to 18-year-olds reported calling in refills (13%, 27%), scheduling clinic appointments (9%, 6%), preparing questions (9%, 16%), and taking the main role in talking in clinic visits (36%, 45%). Responsibility for behaviors gradually increases with age, but did not differ significantly between 2008 and 2011.

Conclusions: Increasing awareness around transition readiness for pediatric providers had an insignificant effect on the self-management skills of patients with IBD. A more formal or structured approach is likely required to improve transition skills in adolescent patients.

*Center for Inflammatory Bowel Disease and Division of Gastroenterology and Nutrition, Boston Children's Hospital

Department of Pediatrics, Harvard Medical School, Boston, MA

University of Amsterdam, Amsterdam, The Netherlands

§Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA.

Address correspondence and reprint requests to Laurie N. Fishman, MD, 300 Longwood Ave, Boston MA 02115 (e-mail:

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The authors report no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work, provided it is properly cited. The work cannot be changed in any way or used commercially.

Received November 19, 2013

Accepted April 11, 2014

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,